Do you tell a 90 year old parent that they have cancer?

Unfortunately, you have to be the one to put on the brakes with the doctors. Some will keep testing and treating without any logic or compassion. I even know of a situation where a mammogram was ordered for a woman in the final stages of ALZ! Imagine how upsetting and confusing these tests and procedures are for someone so cognitively compromised!
Some doctors won't even take no for an answer. Our relative's doctor went to his hospital room after visiting hours and had him sign off on a procedure that the doctor was explicitly told by the patient's medical POA that he was not permitted to do. He was clearly impaired, yet the doctor forged on ahead. It was like the hospital was trying to squeeze the last penny out of Medicare before he was transferred to hospice.

That is true. The docs seem to want to go on testing and testing. A friend's husband had terminal cancer and I was staying with her at the time and we were going to the hospital daily. They shipped him over to another hospital for some tests a couple of times when I was there which left him on a stretcher in a draughty hallway for some time and very uncomfortable. She was commenting on it, and I told her they did not have to agree to the testing. She talked with the doc and there was no more. He died a few weeks later, but at least his last days were as comfortable as possible.

I am facing the same situation with my dad. He is 91 and was diagnosed with a 10cm mass in his lung in March. They found this when we took him to the ER and they found he had peumonia. Two months later by a bronchioscope, the cancer was detected. Radiation, Chemo and surgery are not an option according to the pulmonary doctor due to his age. This is not cure but only the possibility that treatment would slow it down. He has squimascell. The family doctor, who by the way, has only treated him for three months after his other primary retired, feels my dad should know. My dad poor vision due to macular degeneration and is depressed already with the limits of his vision. He is taking an anti depressant, but has a doctor's appointment tomorrow and I know this doctor is going to give him this diagnosis. He already seems to have given up without knowing this. My fear is that he will just give up and lose his will to live.
I'm not sure that we have done the right thing and have struggled with this, yet, I know my father like this doctor never will.

Kevin 10cm is pretty big, and Dad is no fool. He knows there is something going on even if he doesn't say it. When you are 91, you know your body pretty well and you have also learned to read your MD and your children. You can't hide the truth.

Kevin Pam beat me to it, but I was going to say much the same and had also suggested hospice too

There is no right or wrong answer. My mother was diagnosed with stage IV breast cancer at 91. The tumor could not be removed due to its location. Her skin was too fragile for radiation. Palliative care was all the doctor could offer and a hormone stopping drug. My mother is now 96. At some point she opted for a wee course of radiation. Each case is different. Each person is different. Recognize that. Respect that. Most importantly is have a doctor you trust.

I have to say I agree with all of the above answer. My mother was diagnosed with Dementia at age 67. Even though 67 is young. My mother had a terminal illness. I worked in Geriatric Research for many years. I asked my mother 25 years prior about advance directives. But, never got an answer. My mother was care by a geriatrician. My knowledge of palliative care. I stopped all well visits and mammograms, colonscopy etc. I didn't want to add to any discomfort mentally or physically. My mother was complete comfort care no CPR or hospitalization. 2 years later my mother was weak. I did follow up with a hemotologist. My mother had MDS which is chronic bone marrow failure. I did agree to give my mother Procri, which meant she would have to go to the lab for a blood draw to know how much Procrit to give. My mother had some quality of life in her home. I was my mother's health care proxy. I have 3 siblings, I wanted them to understand her health issue and be on the same page as me and the where. It took me 2 years to bring my family to the table and the doctor explained the situation. We where on the same page. My sister lived with my mother for 4 years. Them my sister wanted to move and I moved in with my daughter and husband. I worked during the day. I knew I had to be home by 5 pm because my mother was a sundowner. I found my mother easy to care for and my husband was home during the day and kept an eye on her. The years pasted and I watched my mother's dementia progress. She would get up at night at the same time and asked me the same question every night at 2 am. I would give her the same answer and put her back to bed and she would go back to sleep. I always promised myself, I would never put her in a nursing home because I understood institutional living. I could not deal with it. If you can't deal with it keep them home. I worked in a long term facility for 32 years. I never told my mother about the MDS because she would not understand and it would make her confused and agitated. 12 years past since my mother was diagnosed with dementia and 10 years the MDS. I stopped working the summer of 2010. In the fall, I noticed my mother begin to fail. I called the hematologist. She felt my mother Procrit stopped working. January 2011 my mother fell from the top of the second floor stairs. My husband was at her head all I could do was give him towels to control the bleeding from her head. She was taken to the hospital. I had to track down my siblings and get my daughter and on to the hospital. It was well know at the hospital. My mother was comfort care only. She did need to have her head fixed which they did with sutures and staples. Also, unknowning to me the hospital gave her a blood transfusion. My husband was with her but did not convey her comfort care status. Her red blood cells where very low. I was upset about the transfusion but it was done and that was it. She was admitted to the trauma unit for 5 days. On the second day, I decided to bring my mother home on hospice. We moved the living room furniture and I bought a bed and all the equipment from hospice including a hospital bed. I had hired a CNA, Monday to Friday for 8 hrs a day. The CNA was wonderful a couple of months passed and my mother was getting weaker and weaker. I had a box of medicine and I wasn't shy about giving meds as needed. It was July 18th, I was alone with my mother. It is well know with dementia there is a moment of clarity and I saw my older mother. The only thing she said to me was "Mary please let me go. I've had enough". It was like a ton lifted off my shoulders. My mother decided her own desnity. On Friday we could see her fading away. She had a fever and rapid pulse. Hospice told me if this continues she would not make it through the weekend. I kept my mother very comfortable. My family spent the weekend at the house. I got into bed with my mother on Saturday night and just held her hand. At this point we where giving Morphine every hour. She had more discomfort and increased the dose as needed. Saturday into Sunday and I gave her the last dose of Morphine at 2p. I noticed a change and told my family death would be soon. At 2:20 on Sunday, July 17, 2011 my mother died peacefully in her own home. The MDS at the end turned into Leukemia. My mother knew all her children by name. I never regretted any thing in 12 years. If I had to do it over again. I would do it the same way. Cancer grows very slowly in the elderly. They usually die from some other complication. This is the first time I have spoken about my mother who died at 79 still considered young. It doesn't matter what age. If they have a terminal diagnosis. It make no sense to upset them and we shouldn't feel any guilt. We all want the best for our love one.

My Father had bladder cancer, a little over a year later it spread to his prostate and bones. He was 85 we did all palliative care per his request and kept him at home. He only lived 6 weeks after his diagnosis and was peaceful and comfortable. If some one has Alzheimer's disease I think it would be cruel and unusual punishment to put them through chemo or radiation. In my mind palliative care, or comfort care is what you are looking for.

Personally, from my experience, I agree with Jaye above---it is cruel to have a loved one at this advanced age go through treatments. My mother, who was a RN in her career, was diagnosed with lung cancer (second time--first time was age 60)at age 82. Mom knew what was best for her and wanted no life extending treatments or chemo. She was tired and she stated so to the family. My best girlfriend, on the other hand, had her 94 year old father go through all kinds of things, blood transfusions , tons of meds etc. He finally did pass but suffered through the entire regimen. It really is something that must be discussed with your loved one and let them decide their course of treatment. Prayers to all of you.

If it was me, yes, I would want to know. I would be very upset if my kids kept that news from me.

Kathleen thank you for sharing your story. It was very moving and exactly what i would have done in your shoes. You allowed a merciful end and made excellent use of the medications at your disposal. Your nother must have felt very safe in your arms as she passed.

I do not understand people who say: do not tell someone because of his/her advanced age. Older adults probably handle things a lot better than the "young-uns" do!

CBHillman, I happen to agree with you, but it occurs to me that all of the seniors I have known well were or are, in their different ways, pretty tough old cookies. There was another post on this forum a few days back, though, which might illustrate why some people feel very differently. The OP was asking advice about how to tell her mother she couldn't go home from hospital but would have to move first to rehab and then to an NH. From the medical background the OP provided it was a racing certainty that her mother wouldn't be long in the NH, if she got there at all; but the OP herself didn't appear to have grasped that point. That, really, can only have been because she didn't want to process the information. Should we have enlightened her, or dropped heavy hints, or just left her to imagine what she was comfortable with?

However, one of the points that does worry me more about the 'don't tell' policy is the question of how a person can prepare himself for death if the information is withheld. I suppose it's a matter of timing, in some cases, and capacity in others.

Henry VIII's entourage had a particular difficulty which at least we don't have to wrestle with: in his time - by his act, indeed - it was treason, a capital offence, to "prophesy the death of the King." Since the old fox had his hand over a good bundle of death warrants ready for signature even as he himself was dying, you can get some amusement from picturing Cranmer and the rest of them round his bedside, plucking up the courage to suggest the last rites. Can't remember who drew the short straw… but I think the information was received with good grace in the end.

It would depend on what mental and physical condition they were in. My first reaction would be "Why" They are 90 years old. Do they need something else to worry about? Most likely doctors would not do anything about it if they did have it and so what is the point. Common sense has to rule here.

Why? - Because people have a right to know what is happening to their own bodies. Age is not relevant to that. Or if you think it is, then I'd ask at what age you think you will want to give up your right to give your informed consent to your own treatment?

But for the sake of kindness and sensitivity then, yes, it must depend on what you know of the person and whether you judge that that individual - not that poor old person, but that particular, thinking (or not), feeling (or not) human being - would expect to be told the truth.

I work with elderly people with dementia of all levels everyday, and believe me it is not cut and dried as to whether you should tell them anything of that sort. Don't try and make it a "poor old person" or "human being" or "kindness" thing and they have the right to know thing. You sound like you are way too close to the situation to make any kind of rational decision. It is up to you what you choose to do. Doesn't mean it will be the right thing to do. Sounds like you need more info and that you have already made up your mind anyway. Good luck to you and hope it all works out.

While each situation is different....I would take the...don't ask, don't tell approach.
If she asks, don't lie, but give her the info. However, I wouldn't volunteer the info unless she asks.

No not at this age what good would it do?

Im going through this also. 89 year old mom with alzheimers and recently found out to have lung cancer. My goal as a caregiver has always been to keep her as happy and comfortable as possible. That hasn't changed and telling her would not help achieve that goal.

my mother was diagnosed with stage 4 rectal colon and stomach cancer she has CHF COPD she is alert and knows the situation she is 90 and does not want treatment she has already made her own plans Hospice has been envolved and care being provided how long would a person last without treatment she is also a DNR how do I approach this as she is fully aware of what is going on

This is to a flippant answer but your mother will probably last longer without any treatment.
The important thing is to co-operate with hospice to control her pain and other symptoms. Let Mom take the lead.
If she does not want certain medications don't force her. Many people are very fearful of morphine but it does an excellent job of controlling pain and the distress associated with difficulty breathing.
The DNR is not a major problem just make sure everyone knows she has it. it really comes into play is she has a stroke or heart attack and someone calls 911 which as you know you should not do for a hospice patient. The EMTs can be very aggressive in wanting to treat but if you show the DNR they have to abide by that. Make several copies and post them prominently where everyone can see them but out of Mom's sight. The main thing is to prevent anyone starting CPR or intubating her
Don't be afraid to question hospice every step of the way they are there for you too.
Not having any information on Mom I can't begin to guess how long Mom has left and for the family this really is the hardest time. it sounds as though she is a very put together lady and very ready to let nature take it's course. Make sure you take care of yourself and get plenty of rest and good food. Don't be afraid to go out and have someone sit with her. Of course she may die while you are gone but many people do actually wait till their nearest and dearest are absent to slap away. It would be the way she wanted it not something you missed. Blessings to Mom and your family.

How do you approach what? It doesn't sound as if there is much left for you to do, if your mother is fully aware of her own condition and able to understand the implications of refusing treatment.

If you're at a loss as to what to say to her about it, I'd suggest asking her if there is anything she wants to talk about, or would like someone to explain.

If you yourself are unhappy with decisions she has made, or want to know more about how her condition is likely to develop, ask her hospice team for help and advice. If they can't answer your questions, they are likely to know who can. I'm sorry you're going through this - don't forget to take care of yourself, too.

Sounds like the same thing with my mother but she ask over and over what did they find I want the truth, so we told her and she had us write down her wishes, pass away at home with hospice care she was very alert and knew what was being talked about, I will be saying with her with help, she is 90 with other ailements, my brother wants her to go to a nursing home, she said NO the Doctors said her body is dying right now but her mind has not reached that point, sad to see, but know she will be better off with God, just having a hard time with the brother he has PTSD and can frighten her, also how do I get a DNR she states it but is there a sticker so unsure where to get one.

"Mom: The truth is, you have serious complications. You have this...this...this..., and it is just all getting worse mom". She already had you write down her wishes, she wants to pass away at home. Hospice is your #1 resource right now, including the DNR sticker, etc.
Other papers could be filled out, ask hospice.
There is a paper here in Calif. call the POLST. Good to have.
I guess ask hospice if any of this needs to be video taped? or recorded? or signed?
Is her will and financial paperwork all in order? Hope so.

Like ChurchMouse says: We are very sorry to know you are undergoing the painful present of seeing mom drifting away. You need to stay strong, be there for her, I personally do not believe at this stage that the word or answer "cancer" is necessary. Mom could not go thru it, so, not fibbing, but not saying is my choice.
Just complications................

Keep us updated please, we are here for you.

M88

I would say if your parent is fully aware and knows there is something wrong. I would tell her she has cancer. She is also terminal. I believe at 90 you have lived your life and I can't imagine putting a 90 yr old through chemo etc. What is her quality of life going to be? It is not worth putting them through treatments. I am a believer of comfort care and Hospice. If your mother has some Dementia. I would not say anything to her. Just let her be. I spent 32 years working with the elderly. I have seen good decisions made and terrible decisions made. I have seen elderly who have no religious belief put themselves through h3ll. They honestly belief once you die, In the ground you go and it is the end. I have seen the elderly who have some faith or belief in God and they usually want comfort care and Hospice care. My mother had dementia which is terminal disease. She also, had MDS which changed to Leukemia the last 6 months of her life. I did not try to explain anything to my mother. I kept her home and gave her comfort care and hospice care. My family does believe in God, especially my mother. For my family and my mother it was nice to have her at home and she was happy to be home. We knew she was comfortable to the end. This left me with no regrets. My mother had dementia for 12 years and I went back home with my family and cared for my mother the last 8 years of her life. July will be 5 years since she died. I cannot believe that much time has past. My circumstances allowed me to be with her. Not everyone can do this and one should feel guilty, if you have to place your loved one.

My mother did some things she has not done she has been bed riden since her end of days she got up and stood by the bed told the care giver to cut off her catheter?? Do people do these things scared me She has talked to and seen things which I understand is normal but no one said this

How long has she had a catheter?

Could it be possible it is very painful?

Could it be "infected", burning or in the wrong place?

Ask for someone in the doctor's office, or message the doctor. Something could be wrong an mom is trying to get help.

M 8 8

Jovington Nothing is "normal", we hear about different behaviors all the time.
I assume we are talking about a urinary catheter here?
Definitely talk to the Dr's office or if you have Hospice or home care call the RN and she can make a visit and advise.
Catheters can cause bladder spasms which are very painful. They can also become blocked backing up the urine in the bladder.
Normal using should be pale yellow to amber and clear. if it is cloudy has mucous floating in it or bloody there is a problem.
Infections are also very common. If Mom become dehydrated it will become much darker which is typical at the end of life.
Lots of things to consider so you need professional help with this one, but also lots of things that can be done.

Note to everyone this is not the right place to seek medical advice. This is the best place to seek help in making treatment decisions after you have that advice and are uncertain of the best way forward. People here can help based on their own experience and offer support.

Very well written, Veronica, as usual, you are very professional and to the point. Yet, your loving concern shines thru.

Thank You,

M 8 8

I live in Massachusetts, I was my mother's health care proxy. If you choose Hospice. They usually don't go to the hospital. I needed to sign a form. "Do not Treat" and make many copies and give each member of my family a copy and keep a copy on the refrigerator. It statedmy mother was a DNR and Comfort care only. I would need to give the form to a EMT if my mother needed to go to to the hospital. Because they are not going to be treat for there terminal condition or if their heart stopped. If your mother is having trouble with her catheter and Hospice can't fix the problem. She will need to go to the ER to have the problem fixed. One more important reason to go to the hospital is a fall. My mother had a fall and tore her arm open to the bone and needed sutures. I went to the hospital with my mother in the ambulance and gave the the form to the EMT. You can't watch anyone 24/7 and accidents do happen. They elderly do fall. Unfortunately, if they fall and break their hip which is common. They wouldn't have the choice to fix their hip. There would be no surgery. They would be confined to a wheelchair. A fall many time can cause them to fail quicker, especially their cognitive status. This happens too to the elderly who healthy.